Healthcare IT Standards

There are many standards relating to specific aspects of EHRs/EMRs, in many cases competing standards. These include:

ANSI X12: also known as EDI – Electronic Data Interchange – this is a standard format used for transmitting business data, developed by the Data Interchange Standards Association. The parties who exchange EDI transmissions are referred to as trading partners. Data that is transmitted often includes what would usually be contained in a typical business document or form. ANSI is the American National Standards Institute, an independent standards-setting organization similar to ASTM.

CCD: The Continuity of Care Document specification is an XML-based markup standard intended to specify the encoding, structure and semantics of a patient summary clinical document for exchange.

The CCD specification is a constraint on the HL7 Clinical Document Architecture (CDA) standard. The CDA specifies that the content of the document consists of a mandatory textual part (which ensures human interpretation of the document contents) and optional structured parts (for software processing). The structured part relies on coding systems (such as from SNOMED and LOINC) to represent concepts.

The patient summary contains a core data set of the most relevant administrative, demographic, and clinical information facts about a patient’s healthcare, covering one or more healthcare encounters. It provides a means for one healthcare practitioner, system, or setting to aggregate all of the pertinent data about a patient and forward it to another practitioner, system, or setting to support the continuity of care. Its primary use case is to provide a snapshot in time containing the pertinent clinical, demographic, and administrative data for a specific patient.

The CCD specification contains U.S. specific requirements; its use is therefore limited to the U.S. The U.S. Healthcare Information Technology Standards Panel (HITSP) has selected the CCD as one of its standards.
Continuity of Care Document (CCD) and Continuity of Care Record (CCR) are often seen as competing standards.

CCR: The Continuity of Care Record is a health record standard specification developed jointly by ASTM International, the Massachusetts Medical Society (MMS), HIMSS, the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and other health informatics vendors.

The CCR standard is a patient health summary standard. It is a way to create flexible documents that contain the most relevant and timely core health information about a patient, and to send these electronically from one care giver to another. It contains various sections such as patient demographics, insurance information, diagnosis and problem list, medications, allergies and care plan. These represent a “snapshot” of a patient’s health data that can be useful or possibly lifesaving, if available at the time of clinical encounter. The ASTM CCR standard is designed to permit easy creation by a physician using an electronic health record (EHR) system at the end of an encounter.

Because it is expressed in the standard data interchange language known as XML, a CCR can potentially be created, read and interpreted by any EHR or EMR software application.
Continuity of Care Document (CCD) and Continuity of Care Record (CCR) are often seen as competing standards.

CEN EN13606: A standard being developed by the CEN (European Committee for Standardization) workgroup TC 251 on EHR Communications. It has been stated that CEN 13606 can only be regarded as “a specification for exchange of EHR Extracts” and cannot act in the capacity as a full EHR system. CEN EN113606 is in use in Australia and Europe. CEN and HL7 are working to “converge” their standards into a single unified standard.

DICOM: the Digital Imaging and Communications in Medicine is a heavily used standard for representing and communicating radiology images and reporting.

HL7: Both a standards-setting organization and a series of standards for healthcare specific data exchange between computer applications. HL7 messages are used for interchange between hospital and physician record systems and between EMR systems and practice management systems; HL7 Clinical Document Architecture (CDA) documents are used to communicate documents such as physician notes and other material. Another pertinent example is the HL7 standard called CCOW (after the Clinical Context Object Working group) which, when implemented, allows single-signon to multiple clinical applications, where the clinical context (patient and provider) is preserved as switching between applications. CEN and HL7 are working to “converge” their standards into a single unified standard.

ISO TC215: The International Organization for Standardization (ISO) is an international standard-setting body composed of representatives from national standards bodies. ISO TC215 standards are used in Europe.
openEHR: public specifications and implementations for EHR systems and communication, based on a complete separation of software and clinical models. The openEHR Foundation is a not for profit foundation supporting the open research, development, and implementation of EHRs.

XML: Extensible Markup Language is a general-purpose markup language for creating special-purpose markup languages, capable of describing many different kinds of data. Its primary purpose is to facilitate the sharing of data across different systems, particularly systems connected via the Internet. Languages based on XML (for example, Geography Markup Language (GML), Physical Markup Language (PML) are defined in a formal way, allowing programs to modify and validate documents in these languages without prior knowledge of their form.


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